Situation in Ontario ICUs like a never-ending 'fire' amid COVID-19 3rd wave, says nurse
'We're going to fight the fire, but the fire is going to be there when we leave,' says Clare Fielding
As admissions to Ontario's intensive care units reach record highs, one critical care nurse says the situation is like a "fire" that never goes out.
"That's what we're facing each morning when we get up and we head to work," said Clare Fielding, a clinical nurse specialist for critical care at Toronto General Hospital.
"We're going to fight the fire, but the fire is going to be there when we leave and it's going to be there tomorrow as well."
Ontario is currently grappling with a third wave of COVID-19 infections largely driven by variants of concern. According to the province's science round table, the variants lead to greater hospitalizations and ICU occupancy, and are affecting younger people more seriously.
According to the Ontario health ministry, 451 patients were being treated for COVID-19 in the province's ICU beds as of Saturday morning.
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Even with a month-long stay-at-home order, health experts say that ICU admissions will likely top 800 this month.
On Thursday, Premier Doug Ford announced the province would enter a four-week "emergency brake" shutdown starting April 3 at 12:01 a.m. He stopped short of issuing a stay-at-home order but acknowledged the impact of new COVID-19 variants on hospitals.
"I know pulling the emergency brake will be difficult on many people across the province, but we must try and prevent more people from getting infected and overwhelming our hospitals," said Ford in a press conference.
"Our vaccine rollout is steadily increasing, and I encourage everyone who is eligible to get vaccinated. That is our best protection against this deadly virus."
While health professionals had braced themselves for the unknown earlier in the pandemic, Fielding says that with the third wave, they're now worried about what they know is coming.
"What we're dealing with is the fear of the known, just the volume and the intensity and the amount of work it takes to keep people alive in order to give their bodies a chance to heal. It's overwhelming for staff," she told Day 6 host Brent Bambury.
More hospitalizations, younger patients
Shankar Sivananthan, a critical care physician in Toronto, says that what he's seeing in the ICU now is "certainly the most challenging time I've had in the ICU since the pandemic started."
"The number of patients that are coming to the hospital needing to be admitted to hospital, and then subsequently needing to be sent to the ICU, is definitely up. The biggest difference this time around, though, is the age of the patient," he said in a phone interview.
"The last two to three weeks has just been patients half the age of our typical patients, and that's been incredibly challenging."
Some of those patients — people between 30 and 50 years old with no previous medical issues — are on advanced life support because of their COVID-19 infection, noted Fielding.
More than 150 intensive care physicians, including Sivananthan, have signed an open letter to the Ontario government, released Thursday ahead of the province's shutdown announcement, that warns of exponential growth of variant COVID-19 infections that could overwhelm ICUs.
Sivananthan says the letter is intended to be a red flag to government leaders about what's happening in certain parts of the province — particularly among factory and warehouse workers living in low-income parts of Toronto who are more likely to be infected by COVID-19.
"It's really kind of a very regional disease that affects racialized communities with a lower socioeconomic status," he said.
"We as ICU physicians have a unique perspective of what's happening in these communities that aren't always heard. And thankfully, we've got a position where we can try to advocate for them."
Health-care workers considering career change: Fielding
Because COVID-19 infections have centered within a few public health units, Sivananthan says hospitals throughout the province have kept up with ICU demand — but if infections continue as projected, he says capacity could be stretched to its maximum. That means health-care workers may have to begin triaging cases.
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"At the end of the day, it's going to be us at the front lines that are saying, 'I'm sorry, we're unable to give your loved one the care they need because we just don't have the supplies to do it," he said.
"Honestly, that's the worst nightmare for all of us."
While he calls the government's plan a "good try," he worries it's "too little, too late."
Both Fielding and Sivananthan agree that front-line health-care workers are burning out. Fewer staff are willing to pick up overtime and not enough people are being trained to fill gaps in the system, Sivananthan says.
Meanwhile, some are considering their options.
"They're thinking about it now for sure, whether it's early retirement or a change in career or even just a change of nursing environment," said Fielding.
She said they tell her, "I'm going to go work in some other less stressful, less heart-wrenching, less empathy-draining environment, because I just can't do this anymore."
Written by Jason Vermes with files from CBC News. Interview with Clare Fielding produced by Mouhamad Rachini.
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